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Background: Mortality in case of ovarian malignancy is high due to late diagnosis. Early and accurate diagnosis can improve the case specific management. HE4 (human epididymis protein 4) which is proved to be overexpressed in the ovarian cancer cells, is considered a new biomarker for ovarian cancer diagnosis. Aims and objectives: The study was undertaken to evaluate the immunohistochemical expression of HE4 in various epithelial ovarian neoplasm. Material and Methods: It was a cross sectional, prospective, single institution based study, conducted in the department of Pathology in collaboration with the department of Gynecology and Obstetrics, from December 2016 to January 2019 in our institution. A total 71 cases were selected for this study. Results: Serous tumour was the most common epithelial tumour followed by mucinous tumour. Highest percentage of expression of HE4 was seen in high grade serous cancer and malignant endometrioid tumour. Benign serous and mucinous tumour shows negative expression mostly. We found statistically significant correlation between HE4 expression and different types of epithelial ovarian tumours (p=0.000). Conclusions: HE4 was highly expressed in malignant ovarian tumour especially serous and endometrioid carcinoma and can be used as an important biomarker for malignant ovarian neoplasm. Expression in high grade ovarian serous cancer supports its prognostic value also.

Background: Radioactive contamination and chemical pollution of the environment can affect the processes of carcinogenesis, including the formation of malignant neoplasms of the ovaries in women. We used the data of official state statistics for 2000–2020 to test the hypothesis about the effect of radioactive contamination (following the Chernobyl disaster) and chemical pollutants on the incidence of ovarian malignancies in the female population of the Bryansk region. Methods: A variety of statistical approaches were used to estimate the incidence of ovarian malignancies, including the Shapiro–Wilk test, Mann–Whitney U test, Spearman’s rank correlation test and linear regression. Results: We did not establish statistically significant differences in the frequency of primary morbidity of women with malignant neoplasms of the ovaries, regardless of the environmental conditions of living. Furthermore, no significant correlations were found between the frequency of primary morbidity of ovarian malignancies, both with the level of contamination by Cesium-137 and Strontium-90, and air pollution with volatile organic compounds, carbon monoxide, sulfur dioxide and nitrogen oxides. A statistically significant increase in the long-term trend in the frequency of ovarian malignant neoplasms was revealed in the areas of chemical pollution (p = 0.02), however, in other territories, no statistically significant regularities were established. The forecast of the frequency of newly diagnosed malignant neoplasms of the ovaries on average in the Bryansk region shows an increase of 12.4% in 2020 in comparison with the real data for 2020, while the largest increase in predicted values is recorded in the territories of radioactive contamination (by 79.6%), and the least in the combined territories (by 6.9%). Conclusions: The results obtained indicate the need for further work to understand the trends in the presence/absence of independent and combined effects of pollutants and the growth of oncogynecological pathology from the perspective of assessing the distant and regional metastasis, histological and immunohistochemical profile of a specific malignant ovarian neoplasm with levels of environmental contamination.

Objective To investigate the impact of cystectomy for borderline ovarian tumor (BOT) on tumor recurrence compared with salpingo-oophorectomy using inverse probability of treatment weighting (IPTW). Methods A central pathologic review and a search of the medical records from 14 collaborating institutions from 1986 to 2017 identified 4708 women with a malignant ovarian neoplasm. Data for young women with Stage I BOT were extracted. To compare recurrence-free survival between the surgery groups, Cox regression analyses and the IPTW-adjusted Kaplan-Meier method were employed. Results During a median follow-up of 62.0 (1.2-270.4) months, 10 of the 285 patients identified (3.5%) developed recurrence. In multivariate analysis, the practice of cystectomy was not a significant prognostic indicator of recurrence-free survival (hazard ratio [95% confidence interval] 1.276 [0.150-10.864]; P = 0.823). In the IPTW-adjusted cohort, the 5-year recurrence-free survival rates were 95.8% and 96.0% in patients receiving cystectomy and salpingo-oophorectomy, respectively (P = 0.378). Conclusion If patients are selected appropriately, cystectomy in itself may not increase tumor recurrence in young women with early-stage BOT. A large-scale prospective clinical study is necessary to validate this finding.

Malignant ovarian neoplasm is one of the most lethal malignancies among cancers of the female reproductive system. Occasionally, these tumors originate from non-ovarian organs as metastatic lesions since the ovary is a frequent metastatic target of many cancers. However, there limited clinical information on metastatic ovarian carcinoma (MOC) and its hallmarks are unknown. During the period of 1986–2015, 4,284 patients with malignant ovarian neoplasm were identified using the Tokai Ovarian Tumor Study Group (TOTSG) database. Of these, excluding borderline malignant tumor, 3,478 patients with malignant ovarian cancer were extracted. The pathological slides were evaluated under central pathological review. Among them, a total of 143 (4.1%) patients with MOC were identified. The median age of patients with MOC was 54 (29–82) years. The most and second most frequent original tumors were colorectal (43%, N=62) and gastric (29%, N=42) carcinoma, respectively. The rates of carcinoma of the appendix, breast, and pancreas were 8, 6, and 4%, respectively. This is the one of the largest studies clarifying the rates of MOC among malignant ovarian neoplasms. Although the rate is low, we should keep in mind that MOC, particularly from colorectal and gastric cancer should be considered when encountering clinical practice of ovarian cancer.

Background: Ovarian cancer is the third malignant tumor with the high mortality rate beside breast cancer and cervical cancer. CA 125 is one of the earliest tumor markers and often used by clinicians to diagnosed ovarian cancer. One of the criteria for malignant ovarian neoplasms diagnostic is the elevation of CA 125 levels, but CA 125 level milieu is not specifics indicated ovarian cancer. Contrast – enhanced CT scan of the abdomen and pelvis are the initial imaging modality that used to determined further diagnostic for developed treatment. In addition, preoperative discrimination between benign, borderline and malignant mass in the pelvis was needed. Objective: The objective of this study was to evaluate CT scan feature of ovarian neoplasm at various CA 125 levels. Methods: Retrospective descriptive study in Dr. Soetomo General Academic Hospital January 2017 until June 2020, 91 patients of ovarian neoplasm with pathological confirmed enrolled in the study. Patient did abdominal CT scan and CA 125 serum examination before surgery. CT scan feature was evaluated in raw data. Result: From this study, age range was 22-75 years old, 38.46 % sample was at 51– 60 years, CA 125 level range 7.1 – 8749.5 U/ml. Benign ovarian neoplasm samples were 24. 2 % with CA 125 range 13.1-32.5 U/ml, CT scan feature were cystic (100 %), septated (90.1%), with solid component (72.7%). Borderline ovarian neoplasm sample were 3.3 % with CA 125 range 33.8-454.6 U/ml, CT scan feature were cystic (100 %), septated (100%), with solid component (100%). Malignant ovarian neoplasm samples were 72.5 % with CA 125 range 7.1 – 8749.5 U/ml, CT Scan feature were cystic (100 %), septated (98,4%), with solid component (96.9%), contrast enhancement (96.9 %), irregular walls (84,8 %). Of all, 49 samples were found ascites (85,7% were malignant), 39 samples were found peritoneal carcinomatosis (92 % was malignant ovarian neoplasm). Conclusion: There were no difference finding of the CT scan characteristics in benign and borderline ovarian neoplasm group with normal CA 125 levels and elevated CA 125 levels. The difference between malignant ovarian group, in elevation of CA 125 level showed ascites and peritoneal cacinomatosis more.

Patient: Female, 31-year-old Final Diagnosis: Small cell ovarian cancer • hypercalcemic type Symptoms: Abdominal pain • bloating Medication: — Clinical Procedure: Surgery • adjuvant chemotherapy • adjuvant radiotherapy Specialty: Oncology Objective: Rare disease Background: Small cell ovarian carcinoma, hypercalcemic type is an uncommon malignant ovarian tumor entity with an unfavorable prognosis and a short overall survival rate. It mainly affects women of childbearing age. Case Report: We report a case in which a 31-year-old woman with small cell ovarian carcinoma, hypercalcemic type presented with unspecific symptoms. We emphasize the importance of treatment planning and address fertility-sparing surgical procedures, which remain a therapeutic dilemma. Conclusions: The occurrence of unspecific abdominal symptoms, unilateral tumor masses, and hypercalcemia may indicate the presence of malignant ovarian neoplasm in young adults. Histopathological examination of the mass should be performed by an experienced gynecological pathologist. A misdiagnosis can lead to inadequate surgical and adjuvant treatment. Adjuvant multi-agent chemotherapy and high-dose chemotherapy with autologous stem cell rescue may prolong the progression-free interval and overall survival.

Objective High grade serous ovarian carcinoma (HGSOC) is the most common type of malignant ovarian neoplasm and the main cause of ovarian cancer related deaths worldwide. Although novel biomarkers such as homologous recombination deficiency testing have been implemented into the clinical decision-making algorithm since diagnosis, morphological classification and immunohistochemistry analysis are essential for diagnostic purpose. This study aims at identifying histologic and clinical features that can be predictive of patients' prognosis. Methods Morphological and architectural characterization including SET (Solid-Endometroid-Transitional)/Classic features was carried out in a cohort of 234 patients analyzing 695 slides. From each slide tumor infiltrating lymphocyte (TILs), the presence of necrosis, the number of mitoses, the presence of psammoma bodies, giant cells and atypical mitoses were recorded. Morphological heterogeneity was quantified by the Shannon's diversity index (SDI) considering the percentage of each architectural pattern per patient's slide. Results The frequency of architectural patterns and morphological variables varied with respect of the surgical strategy (primary debulking surgery vs interval surgery after neoadjuvant chemotherapy). HGSOCs exhibiting SET features had a longer overall as well as progression free survival. Among SET features, pseudo-endometrioid and transitional like patterns had the best outcome, while it was heterogenous for solid pattern, that had better outcome for BRCA 1 negative and less heterogeneous tumors. In patients submitted to neoadjuvant chemotherapy a higher intratumor heterogeneity as defined by SDI was a negative independent prognostic factor. Conclusions A comprehensive histological examination considering architectural patterns and their heterogeneity can help in prognostication of HGSOCs.

Ovarian cancer is the most common cause of death among gynecologic malignancies around the world, and there are numerous criteria in preoperative differentiation between benign and malignant ovarian mass. The interaction between cancer and platelets is not yet properly known. Here in, we decided to perform a study about platelets indices in benign and malignant ovarian neoplasm to be the basis for the next conclusion. This study is a descriptive and analytic cross-sectional study and the community consists of patient with epithelial ovarian mass who referred to our Gynecology Oncology center of Imam Hospital of Iran. The information about platelet indices in pre-operational period, extracted from the patients files. Then data were analyzed and descriptive statistics using SPSS software were performed on them. To compare variables between two groups, patients with benign and patients with malignant epithelial ovarian tumors, we used t test. Considering the significance of P value below 0.05, there was a significant difference between two groups in WBC count, MCV and Hb, but in platelet count and platelet indices, there were no significant differences. According to our knowledge, our study is the first one about platelet indices difference, between malignant and non-malignant neoplasm of the ovary. In our research, the mean of platelets count and platelets indexes did not differ between the two groups. In most studies, the mean of Hb, MCV, and WBC count were lower in malignant tumors that our results were the same. Further research is needed to confirm our results so that criteria to differentiate benign and malignant tumors and prognostic factors can be completed.

Rationale: Dysgerminoma is a rare malignant tumor of the ovary, more frequently occurring in young women. The main signs of pseudo-Meigs syndrome (PMS) are ascites and hydrothorax accompanying benign or malignant ovarian tumors (no fibroma or fibroma-like tumor). Patient concerns: A 19-year-old woman with fever and chest tightness for 2 days. Diagnoses: Pectoral-abdominal computed tomography (CT) scan and contrast-enhanced magnetic resonance imaging revealed a large amount of right pleural effusion, a small amount of ascites, and a huge abdominopelvic mass measuring about 29.2cm × 11.8cm × 8.4 cm in the left ovary. The result of hydrothorax examination was consistent with the diagnosis of exudative pleural effusion. In addition, Rivalta-test showed a positive result and lactate dehydrogenase was elevated. The histopathological diagnosis was a giant germ cell tumor, which was consistent with dysgerminoma in terms of both morphology and immunophenotype. Based on these findings, a diagnosis of malignant ovarian neoplasm with PMS was made. Interventions: Surgical resection of the tumor was performed. Outcomes: The patient recovered well after operation, and the pleural effusion and abdominal ascites vanished. No recurrence was observed during the 1-year follow-up period. Lessons: Ovarian dysgerminoma with PMS is a rare malignant tumor of the ovary, which often occurs in young women. It should be considered in differential diagnosis of patients with a pelvic mass, ascites and pleural effusion. Early diagnosis and surgical treatment are beneficial to prolonged survival.

Introduction Ovarian cancer has a high mortality and delayed diagnosis. Inflammation is a risk factor for ovarian cancer, and the inflammatory response is involved in almost all stages of tumor development. Immunohistochemical staining in stroma and epithelium of a panel of cytokines in benign and malignant ovarian neoplasm was evaluated. In addition, immunostaining was related to prognostic factors in malignant tumors. Method The study group comprised 28 ovarian benign neoplasias and 28 ovarian malignant neoplasms. A panel of cytokines was evaluated by immunohistochemistry (Th1: IL-2 and IL-8; Th2: IL-5, IL-6, and IL-10; and TNFR1). Chi-square test with Yates’ correction was used, which was considered significant if less than 0.05. Results TNFR1, IL-5, and IL-10 had more frequent immunostaining 2/3 in benign neoplasms compared with malignant tumors. Malignant tumors had more frequent immunostaining 2/3 for IL-2 in relation to benign tumors. The immunostaining 0/1 of IL 8 was more frequent in the stroma of benign neoplasms compared with malignant neoplasms. Evaluation of the ovarian cancer stroma showed that histological grade 3 was significantly correlated with staining 2/3 for IL-2 ( P = 0.004). Women whose disease-free survival was less than 2.5 years had TNFR1 stromal staining 2/3 ( P = 0.03) more frequently. Conclusion IL-2 and TNFR1 stromal immunostaining are related prognostic factors in ovarian cancer and can be the target of new therapeutic strategies.

Meigs’ syndrome represents a triad of pleural effusion, ascites, and an ovarian tumor, which is usually benign, occurring together. We describe here 2 patients with Meigs’ syndrome and 2 patients with pseudo-Meigs’ syndrome. Hydrothorax and ascites symptoms in 4 patients are of outstanding performance characteristics of Meigs’ syndrome and pseudo-Meigs’ syndrome. Ovarian tumors were found by clinical examination and surgically removed. Postoperatively, these signs of hydrothorax and ascites were dissolved completely. Conclusions: These cases highlight the difficulties that may be encountered in the management of patients with Meigs’ syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach, and the adverse impact that Meigs’ syndrome can have on the patient’s condition. Clinical doctors should be alert to this kind of disease under pathological diagnosis in the absence of a clear effect of chemotherapy or radiotherapy and to prevent unnecessary harm to the patient.

Ovarian fibroma is the most common benign solid tumors of the ovary, commonly misdiagnosed as uterine fibromaor as malignant ovarian tumors. It occurs generally in older perimenopausal and postmenopausal women. Occasionally large fibromas may undergo torsion causing acute abdominal pain. Doppler Ultrasonographyimaging is the choice study. CT and MRI are often needed for further characterization and differentiation from other solid ovarian masses. The choice treatment is surgical removal with intraoperative frozensection. Immunohistochemicalanalysis is recommended to rule out the differential diagnosis. Here we present a case of a postmenopausal woman with a large twisted ovarian fibroma reflecting diagnostic and management difficulties including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the surgical approach.

Serous psammocarcinoma is a rare variant of serous carcinoma arising from either ovary or peritoneum, characterized by massive psammoma body formation, low grade cytologic features, and invasiveness. Its clinical behavior is similar to serous borderline tumors with relatively favorable prognosis. We report herein a case of a 60-year-old postmenopausal woman who presented with abdominal distension. Contrast enhanced computed tomography (CECT) revealed calcified pelvic masses with ascites. Elevated serum CA-125 (970 U/mL) suggested malignant ovarian neoplasm. Patient underwent exploratory laparotomy with primary debulking surgery. Histopathology showed bilateral serous psammocarcinoma of ovary with invasive implants on omentum. Adjuvant chemotherapy was advised in view of advanced stage disease, although its benefits are poorly defined due to rarity of the tumor. However, patient opted out of it and is now on follow-up.